Main Repair Swenson Procedure

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This procedure has the merit of being the first rationally designed surgery to treat this condi-tion.5 It was used for many years by Dr. Swenson himself.23 A few surgeons in the world still perform the original Swenson operation.64,65 For this kind of pull-through operation, the patient must be prepared so that the surgeon can approach the abdomen as well as the perineum. Basically, the entire body, below the rib cage is prepared in the usual manner so that the surgeon can approach the abdomen or the perineum several times either by turning the patient from supine into prone position or simply by lifting up the legs to approach the perineum and then down to approach the abdomen. Transab-dominally, the aganglionic portion of the colon is resected including the most dilated portion of the bowel (Fig. 24.1 A). In a case of typical Hirschsprung's disease, only the splenic flexure

Figure 24.1. The Swenson surgical technique.a: Resection of the aganglionic and dilated bowel.b: Pull-through of normal ganglionic bowel. c: Operation finished. From Pen a A. Surgical treatment of Hirschsprung's disease. In: Wexner SD, Bartolo DCC, eds. Constipation: Etiology, Evaluation and Management. New York: Butterworth-Heinemann, 1995:168-175, reproduced by permission of Edward Arnold.

Figure 24.1. The Swenson surgical technique.a: Resection of the aganglionic and dilated bowel.b: Pull-through of normal ganglionic bowel. c: Operation finished. From Pen a A. Surgical treatment of Hirschsprung's disease. In: Wexner SD, Bartolo DCC, eds. Constipation: Etiology, Evaluation and Management. New York: Butterworth-Heinemann, 1995:168-175, reproduced by permission of Edward Arnold.

must be mobilized. Conversely, dealing with a long segment type of disease, it may be necessary to mobilize the right colon to obtain adequate length for the pull-through. The aganglionic portion of the colon below the peritoneal floor is dissected in a very precise manner, staying as close as possible to the rectal wall down to the level of the levator ani muscle. Dissection of the rectum includes the ligation of the middle hemorrhoidal vessels and the use of cautery to the perirectal vasculature (Fig. 24.1). Special care is taken to preserve the anal canal, above the pectinate line. The aganglionic segment of the colon is resected and the new, normoganglionic colon is pulled through (Fig. 24.1B,C) the same space in the pelvis and anastomosed by a conventional, transanal, hand-sewn technique. The basic principles of this procedure are still observed in most modern operations. Swenson developed extraordinary experience with this operation and he and his followers claimed good results.64,65 Despite these reports, some patients operated on by other surgeons were reported to suffer signs and symptoms related to damage of important nerve structures in the pelvis. Because of nerve injury, other procedures were designed, with the specific purpose of avoiding nerve damage in the pelvis. Such procedures were created by Duhamel and Soave.

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Constipation Prescription

Constipation Prescription

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